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Dental treatment plan question



Sep 26, 2016
I would love to get a dentist's opinion regarding my treatment plan. A little back history of my teeth. I have had four root canals, five extractions, and currently have four crowns and one temp that was put in on Friday.

Here is my question/concern. I have a molar (#30) that has a very large and deep filling. It was filled over 20 years ago. Apparently, it now has a crack, too. It is sensitive to hot/cold but doesn't hurt me otherwise. One of the dentists in the office suggested I leave it for now since it's not bothering me and since it's really serving no purpose because there is no tooth above it. Another dentist in the office suggested that I have it prepared for a crown soon. They can't guarantee if there is decay under the filling or not.

The same molar that was on the other side of my mouth had the same situation. It had a very large and deep filling and was filled at the same time. I had it prepared for a crown and then a week or two later, I had discomfort and the tooth ended up needing a root canal. (that was about 10 years ago) I can't help but feel that this molar (#30) will need the same thing and I don't want to go through the whole temp crown and preparation process to end up possibly in pain and having to rush for a root canal. If the odds are that I may most likely need that, I'd rather just have the root canal from the start. Does that make sense?

Can I just request that I would prefer to have a root canal on that tooth? Also, would it make sense to just pull that tooth, too? It has no tooth above it and I'm in no position to have implants at this time. I'm just trying to determine the best approach.

Too many times, I've gone through the whole prep and crown process only to be told days later that I need a root canal, too. Meanwhile, I have to deal with hours or days of pain until I can get in for the appointment. The temp crown I just had put on on Friday, I was told that there is a strong possibility that I will need a root canal due to how deep the filling was. I wasn't told that until AFTER they prepared the tooth. Frustrating! So, now I'm dealing with monitoring if I have pain, etc., instead of just knowing the nerve is gone and I can relax.

I'm planning to get some sort of partial to fill in the gaps where I have teeth missing. Down the road (10+ years) I want to look into getting implants.

I would love to get your professional opinion. Thanks so much!
I'm not a Dentist or a Dental/Medical Professional...but I wanted to share something with you.

I completely understand where you are -- I've had several crown preps in my life and all but ONE needed RCT either before or immediately following crown prep. My teeth are super sensitive (and incidentally, I also have ATN or AFP) and crown prep is often too traumatic for my nerves to the point that they're screaming for relief.

When my life long Dentist retired, it was a real chore to find an EXCELLENT Dentist that I could trust to diagnose me as accurately as possible while not recommending treatment that isn't necessary. Once I found my current Dentist, she convinced me to let her prep #30 for a crown before I had RCT. The tooth had a filling that was decades old and another dentist recently put a new filling into the tooth. That dentist said a filling would be sufficient and never told me I may likely need a crown. This new filling covered the entire chewing surface and the tooth cracked down the side (I strongly suspect because of the large filling that SHOULD HAVE BEEN A CROWN IN THE FIRST PLACE!!). I don't know if it's her technique or her youth or her training or her tools, but my new Dentist managed to give me a beautiful crown on #30 and I didn't need RCT!!

All that said, of course you can request a RCT prior to the crown prep. Your Dentist can talk with you about your concerns and he/she may or may not want to have you try the crown prep before you jump into RCT. No matter what, you're the patient and you're always in control of your treatment options. Are you an established patient with an Endodontist you trust?? All RCT and especially molar RCT should be performed by Endodontists, IMO. RCT is a very specialized treatment and very, very detail oriented in nature. It should always be performed by a specialist -- your chances for treatment success may depend on it, considering your that you have sensitive nerves, too.

I can completely understand your anxiety about having to wait days to have RCT when you're in pain. Just remember that most/all Dentists do provide Emergency treatment, evenings and weekends as necessary for established patients. You're not going to be stuck for weeks with a throbbing tooth!
Thank you for your reply.

Yes, I always go to an endodontist for root canals. I did have one done from a regular dentist on a smaller molar and it took forever. The last one I had done at an endodontist was really fast. They used new technology, I guess, and instead of using the small files by hand to clean out the canals, they used a drill of some sort so it made it really quick. I wish they all did that. ;)

I've been thinking more about this issue with #30 and I guess maybe my dentist office always suggests starting the crown process in case they are able to do it without the RCT. I just hate the guessing game and then ending up in pain and having to have the RCT.

My dentist isn't open on weekends, though. They are on call and I have all of their cell phone numbers but I think that's more for calling in medications for you until they open. I've never called them so I really don't know. I can't imagine, though, that they would have me go into the office on the weekend. Who knows. I hope I don't ever need to find out. (haha)

That was very interesting about what you mentioned about sensitive nerves. You know, I never thought about that. I am very sensitive to pain in general so I wouldn't doubt that my teeth nerves are any different.

At this point, I'm not sure which way to go. Part of me is saying that I should do a RCT on the molar and then get a crown to save the tooth but another part of me is wondering if that is worth is seeing that the tooth is just holding a place and not used for anything else.

I appreciate your help. :)
It really depends on the Dentist -- my Dentist comes in on weekends and even Holidays when established patients have an emergency...my Endodontist does, too. How do I know? Because just like you, I'm terribly anxious about dental pain and I asked both of them what their practice is in the case of an emergency. It's a case by case basis, of course. Depending on symptoms, they may just call in antibiotics and/or pain medication to a pharmacy to hold you over until the next business day OR they may have you come in if they think there's something they could do immediately to east your suffering. So don't assume you're just out of luck if it's a Saturday night and you're suddenly climbing the walls trying to escape your pain -- even if your Dentist is out of town, good providers will *always* offer some after business hours plan (another provider has agreed to take over his patients in case of emergency, etc).

Do what you will with this tooth -- do what feels right for you. If you trust your Dentist, I would recommend you tell him/her of your concerns and ask his/her opinion...they may say having a RCT is necessary anyway depending on what's happening under the existing filling. It's important to note that while imaging has come a LONG way in the last 20 years alone, there are still damages and decay that imaging can't accurately diagnose...so your Dentist (like mine) may not know if your damage goes to the nerve. I'd guess not since you're only having hot/cold sensitivity which just implies the nerve is alive and active.

Incidentally, I think you've stolen chart notes from my Dentist. I swear my journey with #30 is damn near exactly like yours with the same tooth :giggle: For me personally, my Dentist said I didn't necessarily have to have a crown on #30 -- apparently large fillings aren't too dangerous. I wanted the crown because as soon as I saw up close pics of that GINORMOUS filling and several small cracks down each side of the tooth, all I could think of was "My tooth is going to crack and need extraction!!!"....I worried about it constantly. And it was occasionally painful. Now, it's gorgeous with a new crown that looks exactly like my tooth w/o the cracks or fillings and it doesn't ache anymore...so for me, crown was the right decision.

If your Dentist thinks your tooth is viable and the decay/damage is nowhere near the nerve, I'd try the crown prep first. I felt so good with my temporary on #30, I was worried about changing anything (incl. removing the temp to seat the perm crown). I wore my temp for 5 weeks because I wanted to be absolutely comfortable with the new crown and make sure any soreness from crown prep was gone -- as opposed to seating the new crown immediately and then having to drill through it for RCT (what a shame that is!! I've done that and had to replace a new crown and it was an expensive lesson!!).

As far as whether to the tooth is worth saving, yes....our natural teeth are always best in our mouths, RCT or not. I can tell you that I've given up 2 teeth thanks to my ATN (one possibly had re-infection but unsure and other other tooth was sound) -- and the process to replace perm teeth comes with astronomical cost. With my condition, I always fear that I'll end up in terrible pain from *any* dental procedure due to the ATN. My current dentist has been able to give me several fillings, one close to the nerve and I heal up fine. So again, it's all about provider ability and technique for me.

If you want to, please let us know what you decide and how it works out for you. Best of luck.:jump: